摘要
目的 探讨血管内皮功能障碍对胰岛 β细胞分泌功能的影响。 方法 正常体重(NW )组 81例 ,单纯肥胖 (Ob)组 14 0例 ,肥胖伴高血糖 (Ob +HG)组 97例。测定体质指数 (BMI)、腰臀围比 (WHR)、血压、血脂、空腹血糖和胰岛素 (FBG和FIns)及餐后血糖和胰岛素 (2hBG和 2hIns)。采用稳态模式法评价胰岛素抵抗 (HOMA IR)和 β细胞功能 (HOMA β)。用高分辨率血管外超声测定肱动脉对血流介导的内皮依赖性血管扩张 (EDD)及硝酸甘油的扩张反应。 结果 与Ob组比较 ,Ob +HG组WHR、血压、甘油三酯 (TG)、FIns、2hIns和HOMA IR等显著升高 ,HOMA β明显降低 ,并伴有EDD所标志的血管内皮功能显著下降。相关分析显示 ,β细胞功能与EDD在Ob +HG组呈显著正相关 (r=0 2 5 9,P <0 0 5 ) ,在Ob组和NW组无显著相关。在对Ob +HG组影响EDD的因素进行控制后 ,EDD仍与 β细胞功能显著相关 (r =0 4 5 8,P <0 0 1)。多元逐步回归分析表明影响 β细胞功能的主要因素在Ob +HG组为FBG、FIns和EDD ,在Ob组为FBG和HOMA IR。 结论 内皮依赖性舒张功能障碍可能是导致肥胖者 β细胞功能衰退 ,引发 2型糖尿病 (T2DM )的重要危险因素。
Objective To investigate the impacts of endothe li al dysfunction on insulin secretion function in obese subjects with hyperglycemi a. Methods 81 normal weight and healthy subjects, 140 simple obese subjects and 97 obese subjects with hyperglycemia were included in this st udy. The body mass index (BMI), waist-hip ratio (WHR), blood pressure, lipid p rofile, fasting blood glucose and insulin (FBG and FIns) and 2 h postprandial bl ood glucose and insulin (2 hBG and 2 hIns) were measured. HOMA-IR and HOMA- β were calculated. The brachial artery responses to flow-mediated endotheliu m-dependent dilation (EDD) and the nitroglycerin-mediated dilation were evalua ted by the high resolution vascular ultrasound. Results WHR, blood pressure, triglyceride, FIns、2 hIns and HOMA-IR were higher, and HOMA- β and EDD were lower in obese subjects with hyperglycemia compared with simple obese subjects. Regarding pearson correlation between HOMA-β and EDD there e xisted a positive correlation in obese subjects with hyperglycemia(r=0.259, P<0.05)and no correlations in simple obese subjects and normal weight subje cts. Partial correlation analysis showed that there still was a positive correl ation between EDD and HOMA-β in obese subjects with hyperglycemia (r=0.458 , P<0.01) after the effective factors on EDD were controlled. The key fact ors affecting HOMA-β were FBG, FIns and EDD in obese subjects with hyperglycem ia and were FBG and HOMA-IR in simple obese subjects. Conclusion Endothelial dysfunction may be an important risk factor for type 2 diabete s through the deterioration of β-cell function in obese subjects.
